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Marpuriicare Rapid Glaucoma
Progression Detection Protocol

Advanced, timely, personalised care for every patient

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At Marpuricare, our goal is to detect glaucoma progression as early as possible, especially in patients who may be rapid progressors.

Early identification allows us to protect vision with timely, evidence-based treatment.

A “rapid progressor” typically loses vision at ≥ -1.5 to -2.0 dB/year on visual field testing or shows significant structural thinning on OCT.

Every new glaucoma or glaucoma-suspect patient receives:

  • Two Visual Field (VF) tests within 2 months (minimises learning effect and improves reliability)
  • Comprehensive OCT imaging:
    • RNFL scan
    • Macular GCIPL scan
  • Intraocular pressure (IOP) profile
  • High-resolution optic nerve photographs

This becomes the foundation for all future comparisons.

We tailor follow-up to each patient's level of risk.

High-Risk Patients

(e.g., advanced disease, high IOP, disc haemorrhage, suspicious change)

  • Visual Fields: 3 per year
  • OCT: 2 per year
  • IOP check: every visit
Moderate Risk
  • Visual Fields: 2 per year
  • OCT: 1 - 2 per year
  • IOP check: every visit
Low Risk / Stable Patients
  • Visual Fields: 1 per year
  • OCT: 1 per year
  • IOP check: every visit
Why this schedule?

Research shows that ~6 VF tests over 2 years plus regular OCT offers the best chance of detecting rapid progression early.

Visual Field Indicators
  • MD trend worse than -1.5 dB/year
  • New or enlarging scotomas
  • Confirmed progression on GPA
OCT Indicators
  • RNFL thinning of 5 - 10 µm over 1 - 2 years
  • Progressive macular GCIPL loss
  • Change confirmed on 2 scans
Clinical Indicators
  • IOP persistently above target
  • Disc haemorrhages
  • Noticeable change in optic nerve appearance

At Marpuricare, we follow a structured, safety-first plan:

  1. Confirm change with a repeat VF or OCT within 4 - 8 weeks
  2. Reset target IOP (often a 20 - 30% reduction)
  3. Adjust treatment, which may include:
    • Additional or altered topical medications
    • SLT (Selective Laser Trabeculoplasty)
    • MIGS if appropriate
    • Traditional glaucoma surgery for advanced cases
  4. Increase monitoring frequency for the next 6 - 12 months

At Marpuricare, we ensure patients understand:

  • What progression means
  • Why repeated tests are essential
  • How early detection protects long-term vision
  • What personalised treatment plan they will follow

Our communication is always clear, calm, and patient-centred.

We record:

  • IOP and target pressure
  • VF reliability + MD values + GPA summaries
  • OCT RNFL and GCIPL trends
  • Optic nerve photos
  • Medication changes
  • Whether patient meets criteria for “suspected rapid progressor”

This ensures continuity of care and precise clinical decision-making.

Risk Level Visual Fields OCT Review Interval
High Risk 3/year 2/year Every 4 - 6 months
Moderate Risk 2/year 1 - 2/year Every 6 months
Low Risk 1/year 1/year Yearly

This ensures continuity of care and precise clinical decision-making.